Provider Demographics
NPI:1679239206
Name:OKOLO, SONIA UCHECHUKWU (PA-C)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:UCHECHUKWU
Last Name:OKOLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N ST SE BLDG 175
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20374-5162
Mailing Address - Country:US
Mailing Address - Phone:202-433-6364
Mailing Address - Fax:202-433-6288
Practice Address - Street 1:915 N ST SE BLDG 175
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:024-332-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008232363A00000X
DCPA200001327207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant